title: Exercise blood pressure response and perioperative complications after major vascular surgery.
abstract: OBJECTIVE
  Earlier studies have shown that hypertensive or hypotensive blood pressure (BP) response during a preoperative treadmill exercise test in patients with peripheral arterial disease is associated with a two-fold increased risk of cardiovascular events and mortality. However, it is unknown if these patients also experience an increased perioperative complication risk at major vascular surgery.
  
  
  METHODS
  In total 665 consecutive patients with peripheral arterial disease underwent elective major vascular surgery (carotid endarterectomy, abdominal aorta repair, or lower extremity revascularization). Perioperative complications (infection, myocardial infarction, angina pectoris, cardiac arrhythmia, heart failure, cerebrovascular accident or spinal cord ischemia, dialyses, amputation, thrombectomy, reoperation or death) were defined as occurring within 30 days after surgery and were collected using medical records. Hypertensive BP response was defined as a difference between exercise systolic BP and resting systolic BP of more than 55 mmHg. Hypotensive BP response was defined as a drop in exercise systolic BP below resting systolic BP.
  
  
  RESULTS
  Patients with a hypertensive BP response during a preoperative exercise test (n = 66) showed a higher risk of early perioperative thrombectomy [hazard ratio (HR) 2.80 95% CI (1.24-6.33)] compared with patients with a normal BP response (n = 582). Patients with a hypotensive BP response (n = 18) showed an increased risk of perioperative myocardial infarction [HR 3.69 95% CI (1.08-12.64)] and cardiac complications [HR 2.90 95% CI (1.02-8.19)] compared with patients with a normal BP response.
  
  
  CONCLUSIONS
  Patients with an abnormal BP response have more cardiovascular complications at elective major vascular surgery.
authors.affiliation: Department of Anesthesiology, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Inge I
authors.initials: II
authors.lastname: de Liefde
authors.forename: Gijs M J M
authors.initials: GM
authors.lastname: Welten
authors.forename: Hence J M
authors.initials: HJ
authors.lastname: Verhagen
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: Stolker
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D007022:Hypotension / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures